2 questions re: self-pay (in the US)

sleepyjean · October 17, 2005

If you were self-pay in the US, how much did you pay out of pocket and how long was the wait between the first evaluation and the actual procedure? Oh, and a third question – does that same doctor do your fills?

Thx

SJ

My_o_My · October 17, 2005

1. My pre op visit was covered (I didn't realize that until after my insurance paid for it). Since the doctor - is a doctor - he diagnosed chest pain and shortness of breath (a basic for all pre bandsters for acid reflux and being out of shape).

Anyhoo - because there is a diagnosis of Chest Pain and SOB your PFT's, EKG, and labs are covered. Of course, my colonoscopy and endoscopy were covered for this same diagnosis, and I have a 50% psych benefit so the shrink cost me $125.

Basically - if you have insurance - a doctor worth his salt shoudl be able to code (give you a dsm3) that would cover all the tests so you wouldn't have to pay out of pocket. If you have no insurance at all - I think these tests could get rather pricey.

My doctor does my fills - but he charges after the first one.

As a self pay - the wait is SHORT usually as quick as you can get it scheduled and get the tests done. They love the self-pay patients and are usually willing to accomodate you on the date. I wanted to schedule 3 months out (for summer) - but I could have scheduled within the month of my first pre op appointment - as long as I could get all the tests done within that time frame.

BenetP · October 17, 2005

My insuranse didn't cover a cent, despite meeting ther criteria for medical nessy. I paid $10500 for the hospital, $5050 for the surgeon (including all pre-op testing and psych eval.) and 750 for anaesthesia. The program that I went through makes you prove that you are committed to weight loss before scheduleing the operationso the usual wait for surgery is 10 weeks fro when you do the informational seminar. FYI I was able to pay out of pocket (I had been saving up) but the program did offer financing.

Benet

My_o_My · October 18, 2005

Congratulations on your weight loss. I can't remember the breakdown of what I paid, but the total for hospital, surgeon and anesthesia was 11,900. The facility was beautiful - and the treatment was great.

Because of the way my surgeon billed it - my insurance covered the other things (which was really nice). I still had to sell my car - but it's worth it. I drive around this hideous beater car - I had been driving a fully paid for brand new, everything on it Jeep Liberty (so right now I am overweight, driving this junker and I'm new to the area and the kids are in all new schools).

But by next year - I'll hopefully have a new car, and a new body (with some new clothes to go with it). It's definately worth it - every penny if I can get off all this weight.

niche · October 18, 2005

does anyone know what the deal is for notifying your insurance company if you're self-pay? or if i should notify them at all? i know already that they will not cover... but is it in my interest to let them know that i will be having surgery or not? any experiences with this would be helpful. thanks!

October 18, 2005

I had my first evaluation on September 6th,2005 and I have a surgery date for the 20th of this month. I could have got in sooner but I wanted to wait till my daughter had time off from school. I had to pay 12,500 for surgery and 165.00 for psych. evaluation. The 12,500 covers doctor, hospital, anesthesia, and fills for one year. Plus if I have any complications with the band or port within the first year it is free.

ickytazz · October 18, 2005

all cash, i paid 17k.

I could have had my surgery 3 weeks after my first contact with the surgery center, but i was going to be out of town for a few weeks. so it ended up being about 6 weeks after contact

Joyce in VA · October 18, 2005

Mine was $17,000 and includes everything for one year. If anything should go wrong it will be covered.

My_o_My · October 18, 2005

I didn't give any insurance information on my pre op visit. But for all of my lab work and stuff at the hospital - the doctor said with a diagnosis of Chest Pain and Shortness of Breath all the other tests would be covered by my insurance. And my insurance DID cover them. Then, they went and covered my pre op appointment as well - and I had a nice little credit on my account at the office.

They of course didn't cover the surgery, or the fills. If you really need insurance to cover the pre op - and they won't do it for a band surgeon. See a General Practitioner, and have him order your tests, with the correct diagnosis codes - then your surgeon can just get copies. If you have good insurnace they should cover those sorts of tests if you have CP and SOB.